The eye structure is divided into the upper and lower eyelid, and the censorship refers to the space between both eyelid limbus.

The upper eyelid is composed of subcutaneous fat,
orbicularis oculi muscle, orbital fat, tarsus, levator palpebrae superioris muscle, Muller’s muscle and cornea. Each component has an important role and different characteristics according to race, age and gender.

Therefore, only when fully understanding such anatomical characteristics and physiological functions of each component, satisfactory results regarding the upper eyelid surgery will occur.

Why don’t I have double eyelids?

The double eyelid surgery is the most common aesthetic plastic surgery in Asia, because 40-60% of the entire populations are Asians in terms of race, and about half of them lack double eyelids.

Asian eyelids / Caucasian eyelids

The image on the left is the cross sectional diagram of the Asian single upper eyelid, and the image on the right is the cross sectional diagram of the Caucasian double upper eyelid. For Caucasians, the preseptal fat is not placed low and there exists the adhesion of the levator muscle, skin and orbital septum in the tarsus, which is big.

Anatomical Difference

Preseptal fat pad location
(Location of fat in tarsus)

Union location (유합지점)of septum and levator muscle

Height of tarsus

Beginning of medial eyelid fold

Eyelid fold

Asian eyelid

On the tarsus, on the septum

Down to the lower part of tarsus

6.5-8.0mm

Medial canthus

50%

Caucasian eyelid

On the septum

Upper part of tarsus

9-10.5mm

Medial eyelid

100%

Suture (non-incision)

Without a scalpel, the suture (non-incision) method is to fix the crease. This is to unite the levator muscle with the eyelid skin through several stitches, without incision.

The tied strand is hidden durably into the desired crease line to avoid untying. This so-called “quick double eyelid surgery” (20 minutes) without much swelling is popular for people who work. It is appropriate for eyes with thin eyelids and little fat or muscle.

Types of Suture (non-incision)

This employs one suture that is tied and hidden into the muscle,
which allows several consecutive sutures for the formation of crease.

This employs the sutures that are tied in two or three places inside the skin for the crease formation, which is appropriate for thin skin and muscle.
Some patients who have undergone this operation have their creases fade early, but experienced surgeons with advanced technique can prevent it from fading.

Semi-incision

This is a complex method of both suture and incision to complete the disadvantages of the two methods. In the incision method, the entire eyelid is incised, while in semi-incision, only several parts of the eyelid are incised and sutured. Thus, it allows the crease to be hardly lost and the scar to barely remain as well as the fat to be removed. The swelling goes down in five days after the surgery, making it very popular among young women.

Incision

First, the skin is incised with a scalpel along the desired crease line and the levator muscle is cut a little bit and at the orbital fat is taken out. Then, the levator muscle and the dermis layer are tied in some places and the incised line is sutured. It takes a relatively long time for the swelling to fade (1 to 2 weeks) and the eyes to look natural, but it creates a strong crease that lasts a longer time. This is appropriate especially for droopy and fat eyelids.

Overview of the Comparison of Surgery Methods

Method

Characteristic

Surgical time

Swelling after surgery

Surgical mark

Crease loss

Suture

With a little swelling after the surgery, quick return to daily life. No scar makes the double eyelids look natural.

20-30 minutes

Depends on the eyelid condition but relatively rare

Semi-Incision

When the incision is desired but not appropriate, this method is chosen instead of the full incision.

30-40 minutes

Rare

Incision

This is appropriate for thick and fat skin, droopy skin needing resection, blepharoplasty and desire of bigger eyes.

40-90 minutes

Rare

Before the surgery, the crease design and surgery method should be decided in consideration of the most suitable crease type and the eye condition for the overall balance. In most cases, because there is a slight difference in position, size and shape between the eyes and the left and right side of the overall facial shape, it is necessary to observe them all carefully prior to the surgery.

The thickness of the eyelid, the amount of muscle and fat, and the strength to suture should be precisely measured, and the crease line suitable for this measurement should be chosen.

In consultation with the doctor, different crease lines can be drawn in front of the mirror, and the most suitable crease shape and height can be selected.

Infold Eyelid crease

The beginning of the crease line is placed inside the medial canthus, which is more common in the Asian eyelid of which the Mongolian fold (epicanthal fold) is developed.

The infold eyelid crease creates a cute and delicate image, thus suiting small-faced people. This type is preferred when not desiring a high eyelid crease.

Outfold Eyelid crease

The beginning of the crease line is placed outside the medial canthus, which is more common in the Caucasian eyelid and appears in some Asians who don’t have the Mongolian fold (epicanthal fold). The outfold eyelid crease creates a more glamorous and elegant image, thus suiting people with well-defined eyes, nose and mouth.

The principle of the double eyelid is that the fascia (tendon) from the levator palpebrae muscle (eyelid’s opening muscle) is connected to the skin on the crease line, so when opening the eyes, this connected skin is pulled, resulting in a skin fold. On the other hand, the single eyelid doesn’t have such a connection, so when opening the eyes, the skin is not folded resulting in covering the eyelashes and the upper part of pupil.

The double eyelid surgery is to create an artificial connection of the skin and levator muscle in a desired place. As there are orbital fat and different tissues in the levator muscle, it is necessary to manipulate these tissues during surgery. Therefore, the simple suture method is available to the eyes with thin eyelids and little fat, but those with thick and fat eyelids need a more complex technique, such as the semi-incision or full-incision.